The National Institute of Mental Health describes postpartum depression as a mood disorder that can affect women after childbirth explaining,
‘Training health workers to identify signs of depression, sensitizing health providers to address patient needs, and creating a supportive environment at home will help in tackling the issue of postpartum depression.’
Some women experience 'postpartum baby blues' along with physiological and hormonal changes that last up to two weeks after delivery.
When these blues, along with physiological symptoms, continue beyond two weeks and manifest in more severe signs, it usually requires medical help. Depression is more severe and lasts longer.
The birth of a baby triggers numerous emotions in the mother, ranging from joy to fear and anxiety.
As a result, the mother experiences severe mood swings, excessive crying, difficulty bonding with the infant, loss of appetite or overeating, insomnia or sleeping too much, panic attacks - or, in extreme cases, thoughts of harming oneself or the new born child.
Statistics in India
Untoward incidences where depressed mothers have killed their own child have been reported in the US and the UK. In India, such instances go unreported or misreported.
On World Mental Health day (October 10) this year, the National Institute of Mental Health and Neurosciences released India's National Mental Health Survey (2015-2016).
It reported that 1 in 20 people in India suffer from depression.
Depression rates are much higher for women compared to men. And women are particularly prone to depression in their child-bearing years, commonly manifesting as postpartum depression (PPD).
India's reproductive health programs do not include services for prevention or treatment of PPD, despite the need for intervention.
The interventions are mainly medical and partners and families, who are more often not supportive are not included in prevention or any remedial action.
Mothers facing emotional difficulties often do not open up to their families or health care providers about depression due to stigma or social norms that is attached to mental health.
Many women from poorer households may not have easy access to health care or may not be aware of the signs and symptoms of PPD.
And after childbirth, the focus shifts to the child and the mother's well-being receives less attention.
Beyond Hormonal Influence
Since PPD is thought to arise as a result of hormonal imbalance, clinicians often focus on correcting that and providing patients with psychological counseling to address PPD.
But research shows that the condition may be beyond the influence of hormones. The interaction of hormonal and environmental (socioeconomic, cultural and household) factors may also play a role.
A few of those factors are:
Preference for Boys
- domestic violence,
- pressures within joint families,
- lack of support,
- relationship problems with spouse and in-laws
Research from India and other Asian countries has consistently shown that gender-related attitudes can be key triggers for PPD.
The issue of preference for boys is highlighted with the release of Census data every few years. It reflects an underlying culture of misogyny.
Census in 2011, reported a sex ratio of 940 females to 1,000 males, with affluent states like Delhi and Gujarat reporting child sex ratios of 871 and 890 girls to 1,000 boys, respectively.
These figures indicate that women are pressurized to deliver male children. If a women gives birth to a girl child, she would be blamed and tormented by her family members.
The mother beings to feel low in self-worth and gets detached from the female infant and blames the infant for the mishap thus depriving it of love and care.
Isolation- Another Cause for Postpartum Depression
There are some outdated post-delivery rituals and traditions that are practiced to date. This may do more harm than good.
For instance in some areas in the northern and western parts of India, the mother and baby stay isolated from the family and community for 40 days after delivery.
While this may be done to protect them from infection, the isolation makes the mother lonesome and vulnerable to depression.
The poor state of research on PPD limits the understanding of inequities in incidence and treatment. The rates of prevalence of PPD show a wide range - from 6% to 48% of women - depending on where the research was set or modeled.
Another major constraint for treating PPD is the acute shortage of health providers, especially for mental health at primary care facilities.
What can be done
- recruiting more number of gynecologists, midwives, community health workers, pediatricians and allied health professionals
- providing screening, treatment, preventive counseling and rehabilitation services for cases of PPD
- training health workers to identify signs of depression among women
- interventions to reduce gender-based preference
- reducing violence within homes